It's a lock that Congress will pass it; the real issue is the shape it will take

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Volunteers give out wrist bands for patients to return for a free health clinic on Aug. 13 in Inglewood, Calif. As many as 10,000 people sought care during from Aug. 11 to 18, when the non-profit Remote Area Medical organized hundreds volunteer of doctors, dentists, optometrists and nurses to serve uninsured and underinsured people.

From all the attention focused on the rambunctious town hall meetings,
ranting about “death panels”
and repetitive shrieking against government health care on right-wing radio, one might think health reform is pretty much dead in America. Think again.

Health reform is a lock to pass. The only issue is in what form. You need to look past the noise, fear-mongering, misquotes, inconsistent claims, inaccurate assertions and political gamesmanship and pay attention to what is truly at issue as Congress gets down to the business of reform in the fall.

Why am I so certain reform will happen? Well, August is media silly season. Anything that can get you to look up from your beach or lake reading to watch TV tops the news. That is why creepy Michael Jackson, animal abuser
Michael Vick
and a few thousand angry old white guys, some packing heat, all yelling at Congressmen, dominate the airwaves. Summer will soon be over, though, and that signals a return to a very different world of politics and media coverage.

Soon Congress will be back safely inside the Beltway. They will be insulated from their most belligerent constituents, but chagrined enough by their August forays out to their districts, to actually read some of the health reform bill they were sent out to explain. Sure, they will still be the objects of shouting. But now it will be vested interest groups, lobbyists and administration officials who will be in their faces about health reform.

Say what you will about inside the Beltway politics, but it’s that, not right wing radio, town halls or cable TV punditry that will drive legislation in the fall. The network TV anchors will resume their dignified air, correspondents will be back to speculating about the inside baseball of health reform and no one will remember much about which representative looked the most dense in answering basic questions about health reform. It also does not hurt reform’s chances that the President wants reform, his party controls Congress and so do those inside the Beltway who will now have Congress’ undivided attention.

Who is that? The American Medical Association, the pharmaceutical industry, faith groups, unions, nurses, teachers and the AARP, to mention but a few lobbying giants, are all in the reform camp. All will soon be waving their checkbooks and e-mail lists around. They will be joined by a chorus of voices who voted for Obama who want reform done — not to mention the growing ranks of uninsured who are
desperate for care
.

The tanned and rested White House enforcer, Rahm Emmanuel, will visit obstructionist Blue Dog democrats and remind them that if they don’t get with the health reform program their chances of having any cash from the Democratic National Committee or help from the President in their next campaign are tiny. The President will quietly be reminding his base, Congress and the media that he, not Rush Limbaugh, Sarah Palin, Newt Gingrich or Michael Savage, won the election with a promise of health reform and he is now going to see to it that the mandate he won to do so is fulfilled.

So after all the summer sturm and drang settles down we will be left with a Congress and President negotiating out the final details of health reform. Where does that leave you? What is it that you really need to pay attention to?

Whether reform is affordable should be your top concern. Nothing the President or Congress have yet said is sufficient to explain how to pay for extending coverage to those now uninsured. Taxing millionaires is not going to do the job. Savings from more efficiency seem far off in the future. So what is the financing scheme?

The President is talking a lot about covering prevention and securing savings. That is fine but there are two big problems with prevention. A lot of it actually does not work all that well. And, even when it does, savings can be way down the road.

How universal will health reform really be? One way to solve the cost problem is to limit or slow the extension of coverage to those who lack it. Watch time frames and the fine print on how fast extending coverage will proceed.

Government health plan or
co-op
— which will it be? I actually don’t think it matters. Don’t worry too much about which one is put in place. Pay attention instead to how tightly regulated the public option for the uninsured will be and what benefits are in the new plan — lean or rich? The leaner it gets, the more you can expect huge fights over why those covered by better insurance should get more care than those in the government backed plan just because they can afford more.

If you want to play a role in forging health reform, put down your bullhorn and start by presuming that something is going to happen. That said, get ready to pay attention to the details and to pester your congressman lest lobbyists, special interests and pressure groups get the last word.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.